New Rules to Deprive Seniors of Drugs, Doctors

January 28, 2014

The Centers for Medicare and Medicaid Services (CMS) has proposed new regulations that would deprive seniors of vital drugs, says Diana Furchtgott-Roth, director of Economics21 at the Manhattan Institute.

On January 10, CMS published proposed regulations that would severely impact the health of older Americans. First, the regulations would limit the drugs that would be covered under Medicare Part D.

Starting in 2015, CMS would no longer require antidepressants and immunosuppressant drugs to be covered under the plan.

As depression is the most common elderly health problem, those who would no longer have access to the drugs through their insurance could face problems. Immunosuppressants are used in transplant cases to keep the body from rejecting a new organ. Without those drugs, transplants would have lower rates of success.

CMS plans to save $144 million a year with these measures between 2015 and 2019. For some perspective, that is only two-tenths of one percent of total Medicare outlays in 2019.

Second, the proposed regulations are going to impact doctor access. CMS will not cover prescriptions for seniors -- even those who pay for Medicare Part D -- if they receive those prescriptions from doctors not participating in Medicare.

This means that seniors are going to have to see doctors who participate in Medicare.

Unfortunately, that number has continued to drop due to low reimbursement rates and complicated paperwork. In 2012 alone, 9,500 doctors left Medicare.

As more seniors are forced to see a smaller pool of doctors, access to care is going to become more limited.

The 2014 budget cut $10 million in funding from the Independent Payment Advisory board (the board that decides, under the Affordable Care Act, whether drugs and procedures are too costly). Unfortunately, CMS seems to have taken its place in rationing care.